Currently submitted to: JMIR Serious Games
Date Submitted: Apr 8, 2026
Open Peer Review Period: Apr 17, 2026 - Jun 12, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Participants’ Perspectives and Experiences of Virtual Reality-Supported Psychotherapy for Negative Symptoms in Schizophrenia: A Qualitative Study Embedded in the ENGAGE Trial
ABSTRACT
Background:
Negative symptoms (NS) in schizophrenia spectrum disorders (SSD) are strongly associated with poor functional and clinical outcomes and remain an unmet treatment challenge. Virtual reality (VR)-supported psychotherapy may offer a promising approach by enabling immersive, real-time activation and engagement. Additionally, interventions targeting social reward processing deficits in SSD warrant further examination. A VR-supported psychotherapy used in the ENGAGE trial was developed to target NS and social reward deficits in SSD.
Objective:
The aim of this qualitative study was to explore perspectives and experiences of participants receiv-ing VR-supported psychotherapy in the ENGAGE trial to generate in-depth, real-world insights of this novel treatment approach.
Methods:
Semi-structured, individual interviews were conducted with 11 of the 16 participants in the inter-vention group and analyzed descriptively using abductive qualitative content analysis.
Results:
The analysis yielded five categories: Learning about and knowledge of NS, Varying appraisals of VR, Continuation of therapeutic work outside sessions (subcategories: Components supporting conti-nuity and An unexpected contribution), Perceived mechanisms of change (subcategories: Identifica-tion and management of negative thought patterns, Shifting attention toward accomplishments and positive stimuli, Reframing self-criticism and self-compassion, and Reappraisal as a technique to deal with behavioral barriers), and Feasibility and opportunities for refinement. Investigator triangulation and reflexivity ensured trustworthiness.
Conclusions:
Participants expressed good acceptability and feasibility of the VR-supported psychotherapy, with positive cognitive, emotional, and behavioral responses. However, experiences varied considerably, underscoring the importance of personal relevance and tailored, symptom-specific approaches. Mi-nor practical and technical barriers were identified. Findings provided insight into acceptability, mechanisms, and avenues for tailoring VR-supported psychotherapy for NS.
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